Provider Demographics
NPI:1366647414
Name:SCHOUTEN, JOHN R (DDS, MS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:SCHOUTEN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 E 300 S
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-2771
Mailing Address - Country:US
Mailing Address - Phone:801-491-8470
Mailing Address - Fax:
Practice Address - Street 1:378 E 400 S STE 2
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-1982
Practice Address - Country:US
Practice Address - Phone:801-491-9372
Practice Address - Fax:801-491-0856
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT375746-99211223X0400X
WY10551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics